STEPUP MEDICAL PROTECTION PLAN

Company participation guidelines

Suitable for companies with:

1. a minimum of 10 full-time employees; and
2. an AIA group medical insurance scheme (not including voluntary or top-up policies)

Member enrolment guidelines

Eligibility: Suitable for members under an AIA group medical insurance scheme

1. You need to pay the premium for this plan for life. If you do not pay the premium within 31 days of the due date, the policy will be terminated and you / the insured will lose the cover.
2. You may request for the termination of your policy by notifying us in written notice. Also, we will terminate your plan and you / the insured will lose the cover when one of the following happens:
   • the insured passes away;
   • you do not pay the premium within 31 days of the due date.
   We reserve the right to cancel this policy at any time by giving a 30-day prior written notice without cause to the policy owner. The unearned portion of the premium at the time of cancellation without interest shall be returned to you after deducting any debt owned by you to us under the policy.
   
3. We underwrite the plan and you are subject to our credit risk. If we are unable to satisfy the financial obligations of the policy, you may lose your cover and the remaining premium for that policy year.
4. Future medical costs will be higher than they are today due to inflation. Hence, the benefit amounts and the future premium rate of this plan may be adjusted to reflect inflation.
5. Your current planned benefit may not be sufficient to meet your future needs since the future cost of living may become higher than they are today due to inflation. Where the actual rate of inflation is higher than expected, you may receive less in real terms even if we meet all of our contractual obligations.

Under this plan, we will not cover conditions that result from any of the following events:

1. Any treatment, investigations, services or supplies which are not medically necessary.
2. Any pre-existing conditions for which the insured received medical treatment, diagnosis, consultation or prescribed medicines / drugs during the ninety (90) days preceding the effective date of this coverage unless the insured affected by these conditions has been insured under the AIA group medical policy and this plan for a total duration of at least twelve (12) continuous months.
3. Any congenital defect that appears or is diagnosed before the insured reaches the age of 17.
4. Self-destruction, intentional self-inflicted injury or drug abuse.
5. War or warlike operations, civil commotion, any violation or attempted violation of law or resisting arrest, acts of terrorism where the insured is a terrorist, the use of atomic, biological or chemical contamination due to any act of terrorism, when the insured travels to a country at war, or where there is warlike operation, mutiny, riot, civil commotion, martial law or a state of siege, or a war zone as recognised by the United Nations.
6. Pregnancy, miscarriage, child birth, voluntary termination of pregnancy, or complications of them, mental or nervous disorder, except for mental illness and emotional disorder benefit (see benefits schedule of optional outpatient benefit, item 5 for details), AIDS or any complications associated with HIV infection.
7. Cosmetic or plastic surgery, dental care or surgery, corrective aids and the treatment of refractive errors unless necessitated by injury caused by an accident, body check-up, gradual recovery of health or rest care.

The above-mentioned are for reference only. Please refer to your policy contract for the complete list and details of exclusions

1. Premium Adjustment
   In order to provide you with continuous protection, we will annually review and adjust the premium of your plan accordingly at the end of policy year if necessary. During the review, we may consider factors including but not limited to the following:
   • claim costs incurred from all policies under this plan and the expected claim outgo in the coming year which reflects the impact of medical trend, medical cost inflation and product feature revisions;
   • expenses directly related to the policy and indirect expenses allocated to this product.
     
   
   
2. Product Features Revision
   We reserve the right to revise the benefit structure, terms and conditions and/or product features, so as to keep pace with the times for medical advancement and to provide you with continuous protection.

We will give the policy owner a written notice of any revision before any policy anniversary or upon renewal.

1. We only cover the charges or expenses of the insured on a reasonable and customary basis.
   “Reasonable and customary” means:
   • the medical services, diagnosis and / or treatments are necessary and delivered according to standards of good medical practice;
   • the costs of the medical services and the duration of the hospital stay are not more expensive or longer than the usual level of charges or duration for similar treatment in the locality of such service delivered;
   • the medical procedure or treatment during hospital stay is not routinely performed on an outpatient basis and could not reasonably be performed on the insured member as an outpatient according to standards of good medical practice; and
   • does not include charges that would not have been made if no insurance existed.
   
   “Medically necessary” means that the medical services, diagnosis and / or treatments are:
   • delivered according to standards of good medical practice;
   • necessary; and
   • cannot be safely delivered in a lower level of medical care.
   
   Experimental, screening, and preventive services or supplies are not considered medically necessary. We may adjust any and all benefits payable in relation to any hospital / medical charges which is not a reasonable and customary charge.
   
   
2. If the insured is covered by both AIA group medical insurance scheme and StepUp, where the contract terms and/or claim approach vary between two covers, we will make reference to the contract terms and/or claim approach of AIA group medical insurance scheme and assess the claim by StepUp on a special consideration basis. After membership termination in an AIA group medical insurance scheme/not covering in an AIA group medical insurance scheme, we will assess the claim application in accordance with the contract terms of StepUp.
3. If any confinement, surgery and/or medical treatment covered by StepUp is also covered by other group medical policy (if any), you need to make claims in all such group medical policy before claiming the remaining balance of eligible medical expenses from StepUp.
4. An “adjustment factor” is applied to the calculation of the benefit payable when the insured is confined in a hospital room of a type that is at a higher level than the room type corresponding to the plan level chosen, the benefit payable shall be paid according to the benefits schedule, and the adjustment factor will also apply. For details, please refer to the “Adjustment factor” in the brochure.
5. An insured employee and insured dependant under an AIA group medical insurance scheme must enrol in the same plan, including core benefits and optional outpatient benefit, if applicable.
6. Worldwide emergency assistance services are covered during the trip only (except for 24-hour worldwide telephone enquiring services), which are additional benefits. The services are provided by third party service provider(s). AIA shall not be responsible for any act, negligence or omission of medical advice, opinion, service or treatment on the part of them. AIA reserves the right to amend, suspend or terminate the service without further notice.
7. If the eligible expenses have been reimbursed under any law, or medical program or other insurance policy provided by any government, company, other third party or us, such will not be reimbursable by us under this policy.
8. Medical network services and cashless arrangement are additional benefits and do not form part of the contractual service. Medical network services are provided by network doctor. AIA shall not be responsible for any act or omission of network doctor in the provision of medical network services. AIA reserves the right to amend, suspend or terminate these services without further notice.

If you wish to make a claim, you must send us the appropriate forms and proof within 90 days of the date on which the covered event happened. You can get the appropriate claims forms from your financial planner, or by calling the AIA Customer Hotline on (852) 2232 8888 in Hong Kong, or (853) 8988 1822 in Macau, or by visiting any AIA Customer Service Centre. If you wish to know more about claim related matter, you may visit “File A Claim” section under our company website www.aia.com.hk.

You have the right to cancel and obtain a refund of any premiums and any levy paid by giving written notice to us. Such notice must be signed by you and submitted to the Customer Service Centre of AIA International Limited at 12/F, AIA Tower, 183 Electric Road, North Point, Hong Kong or the Customer Service Centre of AIA International Limited at Unit 1903, 19/F, AIA Tower, 251A-301 Avenida Comercial de Macau, Macau within 21 calendar days immediately following either the day of delivery of the policy or the Cooling-off Notice to you or your nominated representative, whichever is earlier.